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Bariatric surgery is associated with clinically meaningful two-year weight loss after semaglutide or tirzepatide intolerance or inadequate response, according to a study published online Nov. 3 in the Annals of Surgery.

Ali Aminian, M.D., from the Cleveland Clinic, and colleagues evaluated two-year weight loss after bariatric surgery among adults with intolerable adverse effects or inadequate weight loss with semaglutide or tirzepatide. The analysis included adults with a body mass index ≥35 kg/m² undergoing Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) from 2018 to 2024 (4,661 had no prior exposure [comparator group]; 61 discontinued semaglutide or tirzepatide; 207 had inadequate weight-loss response).

The researchers found that before surgery, the estimated two-year medication-associated weight change was a 1.4% gain in the intolerance group and 1.5% total body weight loss (TBWL) in the inadequate-response group. Following surgery, in the intolerance group, two-year TBWL was 27.9% and 22.7% after RYGB for patients without and with type 2 diabetes, respectively, and 20.1% and 21.6% after SG.

In the inadequate-response group, corresponding estimates were 35.8% and 27.4% after RYGB and 14.3% and 14.2% after SG. In the comparator group, corresponding two-year TBWL estimates were 33.3% and 28.7% after RYGB and 23.6% and 19.9% after SG. In the inadequate-response group, in an adjusted analysis, RYGB was associated with greater two-year TBWL than SG (32.7% versus 17.8%).

"GLP-1 medications have transformed obesity care, but they don't work for everyone," Aminian said in a statement.

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